Methods for treating allergy and enhancing allergen-specific immunotherapy by administering an il-4r inhibitor

ABSTRACT

The present invention provides methods for treating, preventing or reducing the severity of allergic reactions. The present invention also provides methods for enhancing the efficacy and/or safety of an allergen-specific immunotherapy (SIT) regimen. The methods of the present invention comprise administering to a subject in need thereof a therapeutic composition comprising an interleukin-4 receptor (IL-4Rα) antagonist such as an anti-IL-4Rα antibody.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a Continuation of U.S. application Ser. No.15/842,868, filed on Dec. 14, 2017, which is a Divisional of U.S.application Ser. No.14/294,544, filed on Jun. 3, 2014, (now U.S. Pat.No. 10,392,429, issued on Aug. 27, 2019), which claims the benefit under35 U.S.C. § 119(e) of U.S. provisional application No. 61/830,919, filedon Jun. 4, 2013, the disclosures of each herein incorporated byreference in their entireties.

SEQUENCE STATEMENT

The instant application contains a Sequence Listing, which has beensubmitted electronically in ASCII format and is hereby incorporated byreference in its entirety. Said ASCII copy, created on Dec. 6, 2017, isnamed SequenceList_12_D2.TXT and is 8 kilobytes in size.

FIELD OF THE INVENTION

The present invention relates to the use of interleukin-4 receptorinhibitors to treat or prevent allergic reactions and to improve theefficacy and/or safety of allergen-specific immunotherapy regimens.

BACKGROUND

Allergies and allergic diseases are serious medical conditions withconsequences ranging from non-life threatening responses that resolveover time to life threatening effects such as anaphylaxis. Allergicreactions can result from contact or exposure to a variety of productssuch as certain food items, insect venom, plant-derived material (e.g.,pollen), chemicals, drugs/medications, and animal dander. Currenttreatment options for allergies include avoidance, pharmacologicalsymptom treatment and prophylaxis using allergen-specificimmunotherapies (SIT). Unfortunately, these current treatment strategiesare often inadequate, costly, impractical or involve significant risk.For example, avoidance of allergen is not always possible and cannegatively impact on patient and caregiver quality of life.Immunotherapeutic approaches, on the other hand, involve deliberateadministration of allergen to susceptible individuals and is thereforeinherently risky with the potential for unwanted severe allergicreactions or anaphylaxis. Accordingly, an unmet need exists in the artfor novel therapeutic approaches that prevent or treat allergicresponses and improve the safety and/or efficacy of immunotherapeutictreatment strategies.

BRIEF SUMMARY OF THE INVENTION

According to one aspect of the present invention, methods are providedfor treating, preventing or reducing the severity of an allergicreaction in a subject. The methods according to this aspect of theinvention comprise administering a therapeutically effective amount of apharmaceutical composition comprising an interleukin-4 receptor (IL-4R)antagonist to a subject in need thereof. The pharmaceutical compositioncomprising the IL-4R antagonist may be administered to the subjecteither before, during or after allergen exposure or manifestation of anallergic symptom.

According to another aspect of the present invention, methods areprovided for enhancing the efficacy and/or safety of anallergen-specific immunotherapy (SIT) regimen. The methods according tothis aspect of the invention comprise administering a therapeuticallyeffective amount of a pharmaceutical composition comprising an IL-4Rantagonist to a subject in combination with the SIT regimen. Accordingto certain embodiments of this aspect of the invention, thepharmaceutical composition comprising the IL-4R antagonist isadministered to the subject either before the commencement of the SITregimen or during the course of the SIT regimen. For example, thepharmaceutical composition comprising the IL-4R antagonist may beadministered during the up-dosing phase of the SIT regimen and/or duringthe maintenance phase of the SIT regimen.

According to another aspect of the present invention, methods areprovided for reducing total serum IgE levels in a subject who has beenexposed to an allergen. The methods according to this aspect of theinvention comprise administering a pharmaceutical composition comprisingan IL-4R antagonist to the subject in an amount sufficient to reduce orabrogate IgE production or to reduce or eliminate serum IgE levels inthe subject.

In various embodiments, the pharmaceutical composition comprising theIL-4R antagonist is administered orally, sub-cutaneously,epi-cutaneously or intravenously to a subject in need thereof.

Exemplary IL-4R antagonists that can be used in the context of themethods of the present invention include, e.g., small molecule chemicalinhibitors of IL-4R or its ligands (IL-4 and/or IL-13), or biologicalagents that target IL-4R or its ligands. According to certainembodiments, the IL-4R antagonist is an antigen-binding protein thatbinds the IL-4Rα chain and blocks signaling by IL-4, IL-13, or both IL-4and IL-13. One such type of antigen-binding protein that can be used inthe context of the methods of the present invention is an anti-IL-4Rαantibody such as dupilumab.

Other embodiments of the present invention will become apparent from areview of the ensuing detailed description.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1, Panel A depicts the time course of a peanut allergy mouse modelin which two doses of an anti-IL-4Rα antibody were administered to themice. Panel B shows the extent of anaphylaxis in three groups ofexperimental mice, assessed in terms of core temperature decrease overtime following IV peanut extract challenge. Mice receiving no antibodyare designated with grey filled circles; mice receiving anti-IL-4Rαantibody are designated with black filled squares; mice receivingisotype control antibody are designated with open squares.

FIG. 2 shows the IgE levels of the three groups of mice referred to inFIG. 1 following peanut extract challenge.

FIG. 3 Panel A depicts the time course of a peanut allergy mouse modelin which a single dose of an anti-IL-4Rα antibody was administered tothe mice on Day 13. Panel B shows the extent of anaphylaxis in threegroups of experimental mice, assessed in terms of core temperaturedecrease over time following IV peanut extract challenge. Mice receivingno antibody are designated with grey filled circles; mice receivinganti-IL-4Rα antibody are designated with black filled squares; micereceiving isotype control antibody are designated with open squares.

FIG. 4 Panel A depicts the time course of a peanut allergy mouse modelin which a single dose of an anti-IL-4Rα antibody was administered tothe mice on Day 27. Panel B shows the extent of anaphylaxis in threegroups of experimental mice, assessed in terms of core temperaturedecrease over time following IV peanut extract challenge. Mice receivingno antibody are designated with grey filled circles; mice receivinganti-IL-4Rα antibody are designated with black filled squares; micereceiving isotype control antibody are designated with open squares.

FIG. 5 shows the total IgE levels in the three treatment groups of FIGS.3 and 4 (no mAb treatment, anti-IL-4Rα treatment, and isotypecontrol-treated mice) on Days 12, 26 and 28 of the respectiveexperimental time courses. Panel A shows the results of the experimentsin which a single dose of antibody was administered on Day 13; Panel Bshows the results of the experiments in which a single dose of antibodywas administered on Day 27.

FIG. 6 depicts the time course of a peanut specific immunotherapy mousemodel comprising a sensitizing phase, a SIT build-up phase, and a peanutextract challenge. Five antibody injections were administered to themice on the days indicated.

FIG. 7 shows the extent of anaphylaxis in three groups of experimentalmice subjected to the peanut specific immunotherapy regimen illustratedin FIG. 6, as well as a no immunotherapy control group. Results areassessed in terms of core temperature decrease over time followingpeanut extract challenge. Mice subjected to challenge but receiving noimmunotherapy are designated with open circles and dashed lines (“NoIT”); mice receiving immunotherapy but no antibody are designated withclosed squares and dashed lines (“IT”); mice receiving immunotherapy andisotype control antibody are designated with open squares and dashedlines (“IT+isotype control”); mice receiving immunotherapy andanti-IL-4Rα antibody are designated with closed squares and solid lines(“IT+anti-IL-4Rα”).

FIGS. 8, 9, 10 and 11 show the total IgE levels (FIG. 8),peanut-specific IgG1 levels (FIG. 9), peanut-specific IgG2a levels (FIG.10), and hlgG levels (FIG. 11), in three groups of experimental micesubjected to the peanut specific immunotherapy regimen illustrated inFIG. 6, as well as a no immunotherapy control group. The variousimmunoglobulin levels at Day 77 and Day 96 are shown. Mice subjected tochallenge but receiving no immunotherapy are designated with closedcircles (“No IT”); mice receiving immunotherapy but no antibody aredesignated with open circles (“IT”); mice receiving immunotherapy andisotype control antibody are designated with closed squares (“IT+isotypecontrol”); mice receiving immunotherapy and anti-IL-4Rα antibody aredesignated with open squares (“IT+anti-IL-4Rα”). Each symbol representsthe measured level in an individual mouse.

FIG. 12 depicts the time course of a variation of the peanut specificimmunotherapy mouse model of FIG. 6, in which fewer doses (8 versus 12)of peanut extract were administered during the build-up phase asindicated. Five antibody injections were administered to the mice on thedays indicated.

FIG. 13 shows the extent of anaphylaxis in three groups of experimentalmice subjected to the peanut specific immunotherapy regimen illustratedin FIG. 12, as well as a no immunotherapy control group. Results areassessed in terms of core temperature decrease over time followingpeanut extract challenge. Treatment groups are the same as in FIG. 6.

DETAILED DESCRIPTION

Before the present invention is described, it is to be understood thatthis invention is not limited to particular methods and experimentalconditions described, as such methods and conditions may vary. It isalso to be understood that the terminology used herein is for thepurpose of describing particular embodiments only, and is not intendedto be limiting, since the scope of the present invention will be limitedonly by the appended claims.

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs. As used herein, the term“about,” when used in reference to a particular recited numerical value,means that the value may vary from the recited value by no more than 1%.For example, as used herein, the expression “about 100” includes 99 and101 and all values in between (e.g., 99.1, 99.2, 99.3, 99.4, etc.).

Although any methods and materials similar or equivalent to thosedescribed herein can be used in the practice of the present invention,the preferred methods and materials are now described. All publicationsmentioned herein are incorporated herein by reference to describe intheir entirety.

Methods for Treating, Preventing or Reducing the Severity of AllergicReactions

The present invention includes methods for treating, preventing orreducing the severity of an allergic reaction in a subject. The methods,according to this aspect of the invention, comprise administering atherapeutically effective amount of a pharmaceutical compositioncomprising an interleukin-4 receptor (IL-4R) antagonist to a subject inneed thereof. As used herein, the terms “treat”, “treating”, or thelike, mean to alleviate symptoms, eliminate the causation of symptomseither on a temporary or permanent basis, or to prevent or slow theappearance of symptoms of an allergic reaction. As used herein, the term“a subject in need thereof” means any human or non-human animal who: (a)is prone to allergic reactions or responses when exposed to one or moreallergens; (b) has previously exhibited an allergic response or reactionto one or more allergens; (c) has a known history of allergies; and/or(d) exhibits a sign or symptom of an allergic response or anaphylaxis.

The present invention also includes methods for reducing total serum IgElevels in a subject who has been exposed to an allergen. The methodsaccording to this aspect of the invention comprise administering apharmaceutical composition comprising an interleukin-4 receptor (IL-4R)antagonist to the subject in an amount sufficient to reduce or abrogateIgE production, or to reduce or eliminate serum IgE levels. As usedherein, a reduction in serum IgE level means that the amount of IgEmeasured in the serum of a subject who has been exposed to an allergenand who has been treated with an IL-4R antagonist, is at least 5%, 10%,20%, 50%, 80%, or 90% lower than the serum IgE level measured in thesame or an equivalent subject that has not been treated with the IL-4antagonist. In certain embodiments, a reduction in serum IgE level meansthat no or negligible amounts of allergen-specific IgE are detected inthe serum of a subject.

As used herein, the phrases “allergic response,” “allergic reaction,”“allergic symptom,” and the like, include one or more signs or symptomsselected from the group consisting of urticaria (e.g., hives),angioedema, rhinitis, asthma, vomiting, sneezing, runny nose, sinusinflammation, watery eyes, wheezing, bronchospasm, reduced peakexpiratory flow (PEF), gastrointestinal distress, flushing, swollenlips, swollen tongue, reduced blood pressure, anaphylaxis, and organdysfunction/failure. An “allergic response,” “allergic reaction,”“allergic symptom,” etc., also includes immunological responses andreactions such as, e.g., increased IgE production and/or increasedallergen-specific immunoglobulin production.

The term “allergen,” as used herein, includes any substance, chemical,particle or composition that is capable of stimulating an allergicresponse in a susceptible individual. Allergens may be contained withinor derived from a food item such as, e.g., dairy products (e.g., cow'smilk), egg, celery, sesame, wheat, soy, fish, shellfish, sugars (e.g.,sugars present on meat such as alpha-galactose), peanuts, other legumes(e.g., beans, peas, soybeans, etc.), and tree nuts. Alternatively, anallergen may be contained within or derived from a non-food item suchas, e.g., dust (e.g., containing dust mite), pollen, insect venom (e.g.,venom of bees, wasps, mosquitos, fire ants, etc.), mold, animal fur,animal dander, wool, latex, metals (e.g., nickel), household cleaners,detergents, medication, cosmetics (e.g., perfumes, etc.), drugs (e.g.,penicillin, sulfonamides, salicylate, etc.), therapeutic monoclonalantibodies (e.g., cetuximab), ragweed, grass and birch. Exemplary pollenallergens include, e.g., tree pollens such as birch pollen, cedarpollen, oak pollen, alder pollen, hornbeam pollen, aesculus pollen,willow pollen, poplar pollen, plantanus pollen, tilia pollen, oleapollen, Ashe juniper pollen, and Alstonia scholaris pollen.

The methods of the present invention comprise administering apharmaceutical composition comprising an IL-4R antagonist to a subjectbefore, after and/or during allergen exposure. For example, the presentinvention includes methods comprising administering a pharmaceuticalcomposition comprising an IL-4R antagonist to a subject less than 12hours, less than 10 hours, less than 8 hours, less than 6 hours, lessthan 4 hours, less than 2 hours, less than 1 hour, or less than 30minutes before allergen exposure. In certain embodiments, thepharmaceutical composition comprising an IL-4R antagonist isadministered to a subject several days to weeks prior to allergenexposure (e.g., from about 1 day to about 2 weeks before allergenexposure). The present invention also includes methods comprisingadministering a pharmaceutical composition comprising an IL-4Rantagonist to a subject less than 12 hours, less than 10 hours, lessthan 8 hours, less than 6 hours, less than 4 hours, less than 2 hours,less than 1 hour, or less than 30 minutes after allergen exposure. Asused herein the expression “allergen exposure” means any incident,episode or occurrence during which a subject ingests, inhales, touchesor otherwise is in direct or indirect contact with an allergen.

The present invention also includes methods comprising administering apharmaceutical composition comprising an IL-4R antagonist to a subjectfollowing the manifestation of one or more allergic symptoms in thesubject. For example, the present invention includes methods comprisingadministering a pharmaceutical composition comprising an IL-4Rantagonist to a subject immediately after, 30 minutes after, 1 hourafter, 2 hours after, 4 hours after, 6 hours after, 8 hours after, 10hours after, or 12 hours after the initial manifestation of one or moreallergic symptoms in the subject.

The present invention includes methods for treating, preventing orreducing the severity of an allergic reaction, wherein the allergicreaction is triggered by any of the aforementioned allergens or classesof allergens. For example, the present invention includes methods fortreating, preventing or reducing the severity of an allergic reactiontriggered by consumption or exposure to a food item (e.g., milk, egg,wheat, soy, fish, shellfish, peanut or tree nut). The present inventionalso includes methods for treating, preventing or reducing the severityof an allergic reaction triggered by a non-food allergen (e.g., insectvenom, dust, mold, animal dander, pollen, latex, medication, ragweed,grass, or birch).

The present invention includes methods for treating, preventing orreducing the severity of an allergic reaction comprising administering atherapeutically effective amount of a pharmaceutical compositioncomprising an IL-4R antagonist to a subject in need thereof, wherein thepharmaceutical composition is administered to the subject in multipledoses, e.g., as part of a specific therapeutic dosing regimen. Forexample, the therapeutic dosing regimen may comprise administeringmultiple doses of the pharmaceutical composition to the subject at afrequency of about once a day, once every two days, once every threedays, once every four days, once every five days, once every six days,once a week, once every two weeks, once every three weeks, once everyfour weeks, once a month, once every two months, once every threemonths, once every four months, or less frequently.

The methods of the present invention, according to certain embodiments,comprise administering to a subject a therapeutically effective amountof a pharmaceutical composition comprising an IL-4R antagonist incombination with a second therapeutic agent. The second therapeuticagent may be an agent selected from the group consisting of, e.g.,steroids, antihistamines, decongestants, and anti-IgE agents. As usedherein, the phrase “in combination with” means that the pharmaceuticalcomposition comprising an IL-4R antagonist is administered to thesubject at the same time as, just before, or just after administrationof the second therapeutic agent. In certain embodiments, the secondtherapeutic agent is administered as a co-formulation with the IL-4Rantagonist. In a related embodiment, the present invention includesmethods comprising administering a therapeutically effective amount of apharmaceutical composition comprising an IL-4R antagonist to a subjectwho is on a background anti-allergy therapeutic regimen. The backgroundanti-allergy therapeutic regimen may comprise a course of administrationof, e.g., steroids, antihistamines, decongestants, anti-IgE agents, etc.The IL-4R antagonist may be added on top of the background anti-allergytherapeutic regimen. In some embodiments, the IL-4R antagonist is addedas part of a “background step-down” scheme, wherein the backgroundanti-allergy therapy is gradually withdrawn from the subject over time(e.g., in a stepwise fashion) while the IL-4R antagonist is administeredthe subject at a constant dose, or at an increasing dose, or at adecreasing dose, over time.

Methods for Enhancing the Efficacy and/or Safety of Allergen-SpecificImmunotherapy (SIT)

The present invention also includes methods for enhancing the efficacyand/or safety of allergen-specific immunotherapy (SIT). The methodsaccording to this aspect of the invention comprise administering atherapeutically effective amount of a pharmaceutical compositioncomprising an IL-4R antagonist to a subject just prior to or concurrentwith a SIT regimen.

As used herein, the expressions “allergen-specific immunotherapy,”“specific immunotherapy,” “SIT,” “SIT regimen,” and the like, refer tothe repeated administration of an allergen to a subject over time asmeans for treating or preventing allergies and allergic reactions, or toreduce or eliminate allergic responses. In a typical SIT regimen, smallamounts of allergen are initially administered to an allergic subject,followed by administration of increased amounts of allergen. In certaininstances, the SIT regimen comprises at least two consecutive phases:(1) an up-dosing phase, and (2) a maintenance phase. In the up-dosingphase, increasing doses of allergen are administered until an effectiveand safe dose is achieved. The dose that is established at the end ofthe up-dosing phase is then administered to the subject throughout thecourse of the maintenance phase. The duration of the up-dosing phase canbe several weeks or several months. In certain embodiments, however, theup-dosing phase is of substantially shorter duration (e.g., less thanone week, less than 6 days, less than 5 days, less than 4 days, lessthan 3 days, or less than 2 days). SIT regimens comprising an up-dosingphase of less than 5 days are sometimes referred to as “Rush”immunotherapy or “Rush SIT.” The maintenance phase of an SIT regimen canlast several weeks, several months, several years, or indefinitely.

According to this aspect of the invention, the SIT regimen may compriseadministration of a food allergen derived from a food item selected fromthe group consisting of dairy product, egg, wheat, soy, fish, shellfish,peanut and tree nut. Alternatively, the SIT regimen may compriseadministration of a non-food allergen selected from the group consistingof insect venom, dust, mold, animal dander, pollen, latex, medication,ragweed, grass, and birch.

According to the methods of the present invention, the IL-4R antagonistcan be administered to the subject throughout the entire course of theSIT regimen, or for only a portion of the SIT regimen. For example, themethods of the present invention include administration of atherapeutically effective amount of a pharmaceutical compositioncomprising an IL-4R antagonist to a subject at a frequency of about oncea week, once every two weeks, once every three weeks, once a month, onceevery two months, once every four months, once every six months, or lessfrequently, prior to or during the up-dosing phase. In certainembodiments, the pharmaceutical composition comprising an IL-4Rantagonist is administered to the subject at a frequency of about once aweek, once every two weeks, once every three weeks, once a month, onceevery two months, once every four months, once every six months, or lessfrequently, during or after the maintenance phase.

According to the present invention, the efficacy and/or safety of an SITregimen is “enhanced” if one or more of the following outcomes orphenomena are observed or achieved in a subject: (1) the duration of theup-dosing phase is decreased without compromising efficacy or safety;(2) the duration of the maintenance phase is decreased withoutcompromising efficacy or safety; (3) the number of doses of allergenadministered during the up-dosing or maintenance phase is reducedwithout compromising efficacy or safety; (4) the frequency of allergenadministration during the up-dosing or maintenance phase is reducedwithout compromising efficacy or safety; (5) the dose of allergenadministered during the up-dosing or maintenance phase is increasedwithout compromising efficacy or safety; (6) the frequency of allergicresponses or adverse side-effects triggered by the SIT regimen isreduced or eliminated; (7) the use of or need for conventional allergymedications (e.g., steroids, antihistamines, decongestants, anti-IgEagents, etc.) is reduced or eliminated during the up-dosing and/ormaintenance phases; (8) the level of allergen-induced IgE expression isreduced; and/or (9) the frequency of anaphylactic reactions is reducedor eliminated. The efficacy of an SIT regimen is also deemed to be“enhanced,” according to the present invention, if a subject experiencesfewer and/or less severe allergic reactions following SIT therapy incombination with IL-4R blockade than with SIT therapy alone.

The present invention also includes methods for weaning a subject off ofan SIT regimen. The methods according to this aspect of the inventioncomprise administering to the subject one or more doses of apharmaceutical composition comprising an IL-4R antagonist, and graduallyreducing the frequency and/or quantity of allergen administered to thesubject during the course of the SIT regimen. In certain embodiments,the quantity of IL-4R antagonist is increased while the quantity ofallergen administered as part of the SIT regimen is decreased.Preferably, administration of the IL-4R antagonist will allow the SITregimen to be terminated while still providing adequate protection fromunwanted allergic reactions.

Interleukin-4 Receptor Antagonists

The methods of the present invention comprise administering to a subjectin need thereof a therapeutic composition comprising an interleukin-4receptor (IL-4R) antagonist. As used herein, an “IL-4R antagonist” (alsoreferred to herein as an “IL-4Rα antagonist,” an “IL-4R blocker,” an“IL-4Rα blocker,” etc.) is any agent that binds to or interacts withIL-4Rα or an IL-4R ligand, and inhibits or attenuates the normalbiological signaling function a type 1 and/or a type 2 IL-4 receptor.Human IL-4Rα has the amino acid sequence of SEQ ID NO: 11. A type 1 IL-4receptor is a dimeric receptor comprising an IL-4Rα chain and a γcchain. A type 2 IL-4 receptor is a dimeric receptor comprising an IL-4Rαchain and an IL-13Rα1 chain. Type 1 IL-4 receptors interact with and arestimulated by IL-4, while type 2 IL-4 receptors interact with and arestimulated by both IL-4 and IL-13. Thus, the IL-4R antagonists that canbe used in the methods of the present invention may function by blockingIL-4-mediated signaling, IL-13-mediated signaling, or both IL-4- andIL-13-mediated signaling. The IL-4R antagonists of the present inventionmay thus prevent the interaction of IL-4 and/or IL-13 with a type 1 ortype 2 receptor.

Non-limiting examples of categories of IL-4R antagonists include smallmolecule IL-4R antagonists, anti-IL-4R aptamers, peptide-based IL-4Rantagonists (e.g., “peptibody” molecules), “receptor-bodies” (e.g.,engineered molecules comprising the ligand-binding domain of an IL-4Rcomponent), and antibodies or antigen-binding fragments of antibodiesthat specifically bind human IL-4Rα. As used herein, IL-4R antagonistsalso include antigen-binding proteins that specifically bind IL-4 and/orIL-13.

Anti-IL-4Rα Antibodies and Antigen-Binding Fragments Thereof

According to certain exemplary embodiments of the present invention, theIL-4R antagonist is an anti-IL-4Rα antibody or antigen-binding fragmentthereof. The term “antibody,” as used herein, includes immunoglobulinmolecules comprising four polypeptide chains, two heavy (H) chains andtwo light (L) chains inter-connected by disulfide bonds, as well asmultimers thereof (e.g., IgM). In a typical antibody, each heavy chaincomprises a heavy chain variable region (abbreviated herein as HCVR orV_(H)) and a heavy chain constant region. The heavy chain constantregion comprises three domains, C_(H)1, C_(H)2 and C_(H)3. Each lightchain comprises a light chain variable region (abbreviated herein asLCVR or V_(L)) and a light chain constant region. The light chainconstant region comprises one domain (C_(L)1). The V_(H) and V_(L)regions can be further subdivided into regions of hypervariability,termed complementarity determining regions (CDRs), interspersed withregions that are more conserved, termed framework regions (FR). EachV_(H) and V_(L) is composed of three CDRs and four FRs, arranged fromamino-terminus to carboxy-terminus in the following order: FR1, CDR1,FR2, CDR2, FR3, CDR3, FR4. In different embodiments of the invention,the FRs of the anti-IL-4R antibody (or antigen-binding portion thereof)may be identical to the human germline sequences, or may be naturally orartificially modified. An amino acid consensus sequence may be definedbased on a side-by-side analysis of two or more CDRs.

The term “antibody,” as used herein, also includes antigen-bindingfragments of full antibody molecules. The terms “antigen-bindingportion” of an antibody, “antigen-binding fragment” of an antibody, andthe like, as used herein, include any naturally occurring, enzymaticallyobtainable, synthetic, or genetically engineered polypeptide orglγcoprotein that specifically binds an antigen to form a complex.Antigen-binding fragments of an antibody may be derived, e.g., from fullantibody molecules using any suitable standard techniques such asproteolytic digestion or recombinant genetic engineering techniquesinvolving the manipulation and expression of DNA encoding antibodyvariable and optionally constant domains. Such DNA is known and/or isreadily available from, e.g., commercial sources, DNA libraries(including, e.g., phage-antibody libraries), or can be synthesized. TheDNA may be sequenced and manipulated chemically or by using molecularbiology techniques, for example, to arrange one or more variable and/orconstant domains into a suitable configuration, or to introduce codons,create cysteine residues, modify, add or delete amino acids, etc.

Non-limiting examples of antigen-binding fragments include: (i) Fabfragments; (ii) F(ab′)2 fragments; (iii) Fd fragments; (iv) Fvfragments; (v) single-chain Fv (scFv) molecules; (vi) dAb fragments; and(vii) minimal recognition units consisting of the amino acid residuesthat mimic the hypervariable region of an antibody (e.g., an isolatedcomplementarity determining region (CDR) such as a CDR3 peptide), or aconstrained FR3-CDR3-FR4 peptide. Other engineered molecules, such asdomain-specific antibodies, single domain antibodies, domain-deletedantibodies, chimeric antibodies, CDR-grafted antibodies, diabodies,triabodies, tetrabodies, minibodies, nanobodies (e.g. monovalentnanobodies, bivalent nanobodies, etc.), small modularimmunopharmaceuticals (SMIPs), and shark variable IgNAR domains, arealso encompassed within the expression “antigen-binding fragment,” asused herein.

An antigen-binding fragment of an antibody will typically comprise atleast one variable domain. The variable domain may be of any size oramino acid composition and will generally comprise at least one CDR thatis adjacent to or in frame with one or more framework sequences. Inantigen-binding fragments having a V_(H) domain associated with a V_(L)domain, the V_(H) and VL domains may be situated relative to one anotherin any suitable arrangement. For example, the variable region may bedimeric and contain V_(H)-V_(H), V_(H)-V_(L) or V_(L)-V_(L) dimers.Alternatively, the antigen-binding fragment of an antibody may contain amonomeric V_(H) or V_(L) domain.

In certain embodiments, an antigen-binding fragment of an antibody maycontain at least one variable domain covalently linked to at least oneconstant domain. Non-limiting, exemplary configurations of variable andconstant domains that may be found within an antigen-binding fragment ofan antibody of the present invention include: (i) V_(H)-C_(H)1; (ii)V_(H)-C_(H)2; (iii) V_(H)-C_(H)3; (iv) V_(H)-C_(H)1-C_(H)2; (v)V_(H)-C_(H)1-C_(H)2-C_(H)3; (vi) V_(H)-C_(H)2-C_(H)3; (vii) V_(H)-C_(L);(viii) V_(L)-C_(H)1; (ix) V_(L)-C_(H)2; (x) V_(L)-C_(H)3; (xi)V_(L)-C_(H)1-C_(H)2; (xii) V_(L)-C_(H)1-C_(H)2-C_(H)3; (xiii)V_(L)-C_(H)2-C_(H)3; and (xiv) V_(L)-C_(L). In any configuration ofvariable and constant domains, including any of the exemplaryconfigurations listed above, the variable and constant domains may beeither directly linked to one another or may be linked by a full orpartial hinge or linker region. A hinge region may consist of at least 2(e.g., 5, 10, 15, 20, 40, 60 or more) amino acids which result in aflexible or semi-flexible linkage between adjacent variable and/orconstant domains in a single polypeptide molecule. Moreover, anantigen-binding fragment of an antibody of the present invention maycomprise a homo-dimer or hetero-dimer (or other multimer) of any of thevariable and constant domain configurations listed above in non-covalentassociation with one another and/or with one or more monomeric V_(H) orV_(L) domain (e.g., by disulfide bond(s)).

The term “antibody,” as used herein, also includes multispecific (e.g.,bispecific) antibodies. A multispecific antibody or antigen-bindingfragment of an antibody will typically comprise at least two differentvariable domains, wherein each variable domain is capable ofspecifically binding to a separate antigen or to a different epitope onthe same antigen. Any multispecific antibody format may be adapted foruse in the context of an antibody or antigen-binding fragment of anantibody of the present invention using routine techniques available inthe art. For example, the present invention includes methods comprisingthe use of bispecific antibodies wherein one arm of an immunoglobulin isspecific for IL-4Rα or a fragment thereof, and the other arm of theimmunoglobulin is specific for a second therapeutic target or isconjugated to a therapeutic moiety. Exemplary bispecific formats thatcan be used in the context of the present invention include, withoutlimitation, e.g., scFv-based or diabody bispecific formats, IgG-scFvfusions, dual variable domain (DVD)-Ig, Quadroma, knobs-into-holes,common light chain (e.g., common light chain with knobs-into-holes,etc.), CrossMab, CrossFab, (SEED)body, leucine zipper, Duobody,IgG1/IgG2, dual acting Fab (DAF)-IgG, and Mabe bispecific formats (see,e.g., Klein et al. 2012, mAbs 4:6, 1-11, and references cited therein,for a review of the foregoing formats). Bispecific antibodies can alsobe constructed using peptide/nucleic acid conjugation, e.g., whereinunnatural amino acids with orthogonal chemical reactivity are used togenerate site-specific antibody-oligonucleotide conjugates which thenself-assemble into multimeric complexes with defined composition,valency and geometry. (See, e.g., Kazane et al., J. Am. Chem. Soc.[Epub: Dec. 4, 2012]).

The antibodies used in the methods of the present invention may be humanantibodies. The term “human antibody,” as used herein, is intended toinclude antibodies having variable and constant regions derived fromhuman germline immunoglobulin sequences. The human antibodies of theinvention may nonetheless include amino acid residues not encoded byhuman germline immunoglobulin sequences (e.g., mutations introduced byrandom or site-specific mutagenesis in vitro or by somatic mutation invivo), for example in the CDRs and in particular CDR3. However, the term“human antibody,” as used herein, is not intended to include antibodiesin which CDR sequences derived from the germline of another mammalianspecies, such as a mouse, have been grafted onto human frameworksequences.

The antibodies used in the methods of the present invention may berecombinant human antibodies. The term “recombinant human antibody,” asused herein, is intended to include all human antibodies that areprepared, expressed, created or isolated by recombinant means, such asantibodies expressed using a recombinant expression vector transfectedinto a host cell (described further below), antibodies isolated from arecombinant, combinatorial human antibody library (described furtherbelow), antibodies isolated from an animal (e.g., a mouse) that istransgenic for human immunoglobulin genes (see e.g., Taylor et al.(1992) Nucl. Acids Res. 20:6287-6295) or antibodies prepared, expressed,created or isolated by any other means that involves splicing of humanimmunoglobulin gene sequences to other DNA sequences. Such recombinanthuman antibodies have variable and constant regions derived from humangermline immunoglobulin sequences. In certain embodiments, however, suchrecombinant human antibodies are subjected to in vitro mutagenesis (or,when an animal transgenic for human Ig sequences is used, in vivosomatic mutagenesis) and thus the amino acid sequences of the V_(H) andV_(L) regions of the recombinant antibodies are sequences that, whilederived from and related to human germline V_(H) and V_(L) sequences,may not naturally exist within the human antibody germline repertoire invivo.

According to certain embodiments, the antibodies used in the methods ofthe present invention specifically bind IL-4Rα. The term “specificallybinds,” or the like, means that an antibody or antigen-binding fragmentthereof forms a complex with an antigen that is relatively stable underphysiologic conditions. Methods for determining whether an antibodyspecifically binds to an antigen are well known in the art and include,for example, equilibrium dialysis, surface plasmon resonance, and thelike. For example, an antibody that “specifically binds” IL-4Rα, as usedin the context of the present invention, includes antibodies that bindIL-4Rα or portion thereof with a K_(D) of less than about 1000 nM, lessthan about 500 nM, less than about 300 nM, less than about 200 nM, lessthan about 100 nM, less than about 90 nM, less than about 80 nM, lessthan about 70 nM, less than about 60 nM, less than about 50 nM, lessthan about 40 nM, less than about 30 nM, less than about 20 nM, lessthan about 10 nM, less than about 5 nM, less than about 4 nM, less thanabout 3 nM, less than about 2 nM, less than about 1 nM or less thanabout 0.5 nM, as measured in a surface plasmon resonance assay. Anisolated antibody that specifically binds human IL-4Rα may, however,have cross-reactivity to other antigens, such as IL-4Rα molecules fromother (non-human) species.

According to certain exemplary embodiments of the present invention, theIL-4R antagonist is an anti-IL-4Rα antibody, or antigen-binding fragmentthereof comprising a heavy chain variable region (HCVR), light chainvariable region (LCVR), and/or complementarity determining regions(CDRs) comprising any of the amino acid sequences of the anti-IL-4Rantibodies as set forth in U.S. Pat. No. 7,608,693. In certain exemplaryembodiments, the anti-IL-4Rα antibody or antigen-binding fragmentthereof that can be used in the context of the methods of the presentinvention comprises the heavy chain complementarity determining regions(HCDRs) of a heavy chain variable region (HCVR) comprising the aminoacid sequence of SEQ ID NO:1 and the light chain complementaritydetermining regions (LCDRs) of a light chain variable region (LCVR)comprising the amino acid sequence of SEQ ID NO:2. According to certainembodiments, the anti-IL-4Ra antibody or antigen-binding fragmentthereof comprises three HCDRs (HCDR1, HCDR2 and HCDR3) and three LCDRs(LCDR1, LCDR2 and LCDR3), wherein the HCDR1 comprises the amino acidsequence of SEQ ID NO:3; the HCDR2 comprises the amino acid sequence ofSEQ ID NO:4; the HCDR3 comprises the amino acid sequence of SEQ ID NO:5;the LCDR1 comprises the amino acid sequence of SEQ ID N0:6; the LCDR2comprises the amino acid sequence of SEQ ID NO:7; and the LCDR3comprises the amino acid sequence of SEQ ID NO:8. In yet otherembodiments, the anti-IL-4R antibody or antigen-binding fragment thereofcomprises an HCVR comprising SEQ ID NO:1 and an LCVR comprising SEQ IDNO:2. According to certain exemplary embodiments, the methods of thepresent invention comprise the use of the anti-IL-4Rα antibody referredto and known in the art as dupilumab, or a bioequivalent thereof.

Other anti-IL-4Rα antibodies that can be used in the context of themethods of the present invention include, e.g., the antibody referred toand known in the art as AMG317 (Corren et al., 2010, Am J Respir CritCare Med., 181(8):788-796), or any of the anti-IL-4Rα antibodies as setforth in U.S. Pat. No. 7,186,809, 7,605,237, 7,608,693, or U.S. Pat. No.8,092,804.

The anti-IL-4Rα antibodies used in the context of the methods of thepresent invention may have pH-dependent binding characteristics. Forexample, an anti-IL-4Rα antibody for use in the methods of the presentinvention may exhibit reduced binding to IL-4Rα at acidic pH as comparedto neutral pH. Alternatively, an anti-IL-4Rα antibody of the inventionmay exhibit enhanced binding to its antigen at acidic pH as compared toneutral pH. The expression “acidic pH” includes pH values less thanabout 6.2, e.g., about 6.0, 5.95, 5,9, 5.85, 5.8, 5.75, 5.7, 5.65, 5.6,5.55, 5.5, 5.45, 5.4, 5.35, 5.3, 5.25, 5.2, 5.15, 5.1, 5.05, 5.0, orless. As used herein, the expression “neutral pH” means a pH of about7.0 to about 7.4. The expression “neutral pH” includes pH values ofabout 7.0, 7.05, 7.1, 7.15, 7.2, 7.25, 7.3, 7.35, and 7.4.

In certain instances, “reduced binding to IL-4Rα at acidic pH ascompared to neutral pH” is expressed in terms of a ratio of the K_(D)value of the antibody binding to IL-4Rα at acidic pH to the K_(D) valueof the antibody binding to IL-4Rα at neutral pH (or vice versa). Forexample, an antibody or antigen-binding fragment thereof may be regardedas exhibiting “reduced binding to IL-4Rα at acidic pH as compared toneutral pH” for purposes of the present invention if the antibody orantigen-binding fragment thereof exhibits an acidic/neutral K_(D) ratioof about 3.0 or greater. In certain exemplary embodiments, theacidic/neutral K_(D) ratio for an antibody or antigen-binding fragmentof the present invention can be about 3.0, 3.5, 4.0, 4.5, 5.0, 5.5, 6.0,6.5, 7.0, 7.5, 8.0, 8.5, 9.0, 9.5, 10.0, 10.5, 11.0, 11.5, 12.0, 12.5,13.0, 13.5, 14.0, 14.5, 15.0, 20.0. 25.0, 30.0, 40.0, 50.0, 60.0, 70.0,100.0 or greater.

Antibodies with pH-dependent binding characteristics may be obtained,e.g., by screening a population of antibodies for reduced (or enhanced)binding to a particular antigen at acidic pH as compared to neutral pH.Additionally, modifications of the antigen-binding domain at the aminoacid level may yield antibodies with pH-dependent characteristics. Forexample, by substituting one or more amino acids of an antigen-bindingdomain (e.g., within a CDR) with a histidine residue, an antibody withreduced antigen-binding at acidic pH relative to neutral pH may beobtained. As used herein, the expression “acidic pH” means a pH of 6.0or less.

Pharmaceutical Compositions

The present invention includes methods that comprise administering anIL-4R antagonist to a subject wherein the IL-4R antagonist is containedwithin a pharmaceutical composition. The pharmaceutical compositions ofthe invention may be formulated with suitable carriers, excipients, andother agents that provide suitable transfer, delivery, tolerance, andthe like. A multitude of appropriate formulations can be found in theformulary known to all pharmaceutical chemists: Remington'sPharmaceutical Sciences, Mack Publishing Company, Easton, Pa. Theseformulations include, for example, powders, pastes, ointments, jellies,waxes, oils, lipids, lipid (cationic or anionic) containing vesicles(such as LI POFECTIN™), DNA conjugates, anhydrous absorption pastes,oil-in-water and water-in-oil emulsions, emulsions carbowax(polyethylene glycols of various molecular weights), semi-solid gels,and semi-solid mixtures containing carbowax. See also Powell et al.“Compendium of excipients for parenteral formulations” PDA (1998) JPharm Sci Technol 52:238-311.

Various delivery systems are known and can be used to administer thepharmaceutical composition of the invention, e.g., encapsulation inliposomes, microparticles, microcapsules, recombinant cells capable ofexpressing the mutant viruses, receptor mediated endocytosis (see, e.g.,Wu et al., 1987, J. Biol. Chem. 262:4429-4432). Methods ofadministration include, but are not limited to, intradermal,intramuscular, intraperitoneal, intravenous, subcutaneous, intranasal,epidural, and oral routes. The composition may be administered by anyconvenient route, for example by infusion or bolus injection, byabsorption through epithelial or mucocutaneous linings (e.g., oralmucosa, rectal and intestinal mucosa, etc.) and may be administeredtogether with other biologically active agents.

A pharmaceutical composition of the present invention can be deliveredsubcutaneously or intravenously with a standard needle and syringe. Inaddition, with respect to subcutaneous delivery, a pen delivery devicereadily has applications in delivering a pharmaceutical composition ofthe present invention. Such a pen delivery device can be reusable ordisposable. A reusable pen delivery device generally utilizes areplaceable cartridge that contains a pharmaceutical composition. Onceall of the pharmaceutical composition within the cartridge has beenadministered and the cartridge is empty, the empty cartridge can readilybe discarded and replaced with a new cartridge that contains thepharmaceutical composition. The pen delivery device can then be reused.In a disposable pen delivery device, there is no replaceable cartridge.Rather, the disposable pen delivery device comes prefilled with thepharmaceutical composition held in a reservoir within the device. Oncethe reservoir is emptied of the pharmaceutical composition, the entiredevice is discarded.

In certain situations, the pharmaceutical composition can be deliveredin a controlled release system. In one embodiment, a pump may be used.In another embodiment, polymeric materials can be used; see, MedicalApplications of Controlled Release, Langer and Wise (eds.), 1974, CRCPres., Boca Raton, Fla. In yet another embodiment, a controlled releasesystem can be placed in proximity of the composition's target, thusrequiring only a fraction of the systemic dose (see, e.g., Goodson,1984, in Medical Applications of Controlled Release, supra, vol. 2, pp.115-138). Other controlled release systems are discussed in the reviewby Langer, 1990, Science 249:1527-1533.

The injectable preparations may include dosage forms for intravenous,subcutaneous, intracutaneous and intramuscular injections, dripinfusions, etc. These injectable preparations may be prepared by knownmethods. For example, the injectable preparations may be prepared, e.g.,by dissolving, suspending or emulsifying the antibody or its saltdescribed above in a sterile aqueous medium or an oily mediumconventionally used for injections. As the aqueous medium forinjections, there are, for example, physiological saline, an isotonicsolution containing glucose and other auxiliary agents, etc., which maybe used in combination with an appropriate solubilizing agent such as analcohol (e.g., ethanol), a polyalcohol (e.g., propylene glycol,polyethylene glycol), a nonionic surfactant [e.g., polysorbate 80,HCO-50 (polyoxyethylene (50 mol) adduct of hydrogenated castor oil)],etc. As the oily medium, there are employed, e.g., sesame oil, soybeanoil, etc., which may be used in combination with a solubilizing agentsuch as benzyl benzoate, benzyl alcohol, etc. The injection thusprepared is preferably filled in an appropriate ampoule.

Advantageously, the pharmaceutical compositions for oral or parenteraluse described above are prepared into dosage forms in a unit dose suitedto fit a dose of the active ingredients. Such dosage forms in a unitdose include, for example, tablets, pills, capsules, injections(ampoules), suppositories, etc.

Exemplary pharmaceutical compositions comprising an anti-IL-4R antibodythat can be used in the context of the present invention are disclosed,e.g., in US Patent Application Publication No. 2012/0097565.

Dosage

The amount of IL-4R antagonist (e.g., anti-IL-4Rα antibody) administeredto a subject according to the methods of the present invention is,generally, a therapeutically effective amount. As used herein, thephrase “therapeutically effective amount” means an amount of IL-4Rantagonist that results in one or more of: (a) a reduction in theseverity or duration of an allergic reaction; (b) the alleviation of oneor more symptoms or indicia of an allergic reaction; (c) prevention oralleviation of anaphylaxis; (d) a reduction in serum IgE level; (e) areduction in the use or need for conventional allergy therapy (e.g.,reduced or eliminated use of antihistamines, decongestants, nasal orinhaled steroids, anti-IgE treatment, epinephrine, etc.); and (f) areduced frequency of allergic responses to allergen-specificimmunotherapy (SIT).

In the case of an anti-IL-4Rα antibody, a therapeutically effectiveamount can be from about 0.05 mg to about 600 mg, e.g., about 0.05 mg,about 0.1 mg, about 1.0 mg, about 1.5 mg, about 2.0 mg, about 10 mg,about 20 mg, about 30 mg, about 40 mg, about 50 mg, about 60 mg, about70 mg, about 80 mg, about 90 mg, about 100 mg, about 110 mg, about 120mg, about 130 mg, about 140 mg, about 150 mg, about 160 mg, about 170mg, about 180 mg, about 190 mg, about 200 mg, about 210 mg, about 220mg, about 230 mg, about 240 mg, about 250 mg, about 260 mg, about 270mg, about 280 mg, about 290 mg, about 300 mg, about 310 mg, about 320mg, about 330 mg, about 340 mg, about 350 mg, about 360 mg, about 370mg, about 380 mg, about 390 mg, about 400 mg, about 410 mg, about 420mg, about 430 mg, about 440 mg, about 450 mg, about 460 mg, about 470mg, about 480 mg, about 490 mg, about 500 mg, about 510 mg, about 520mg, about 530 mg, about 540 mg, about 550 mg, about 560 mg, about 570mg, about 580 mg, about 590 mg, or about 600 mg, of the anti-IL-4Rantibody. In certain embodiments, 300 mg of an anti-IL-4R antibody isadministered.

The amount of IL-4R antagonist contained within the individual doses maybe expressed in terms of milligrams of antibody per kilogram of patientbody weight (i.e., mg/kg). For example, the IL-4R antagonist may beadministered to a patient at a dose of about 0.0001 to about 10 mg/kg ofpatient body weight.

EXAMPLES

The following examples are put forth so as to provide those of ordinaryskill in the art with a complete disclosure and description of how tomake and use the methods and compositions of the invention, and are notintended to limit the scope of what the inventors regard as theirinvention. Efforts have been made to ensure accuracy with respect tonumbers used (e.g., amounts, temperature, etc.) but some experimentalerrors and deviations should be accounted for. Unless indicatedotherwise, parts are parts by weight, molecular weight is averagemolecular weight, temperature is in degrees Centigrade, and pressure isat or near atmospheric.

Example 1 IL-4R Blockade Prevents Systemic Anaphylaxis in a Mouse Modelof Peanut Allergy

In this Example, the effect of IL-4Rα blockade on peanut-inducedanaphylaxis in a mouse model was assessed. An outline of theexperimental protocol is shown in FIG. 1A. Briefly, three groups of 5C57BL/6 mice were each sensitized with 100 μg of crude peanut extractand Alum (2 mg/ml) administered by subcutaneous injection on Day 0,followed by a boost injection on Day 14. On Day 28 a challenge injectionof 50 μg of peanut extract was administered intravenously. The firstgroup of mice received no treatment. The second group of mice wereadministered an anti-mouse IL-4Rα antibody (“anti-mlL-4Rα”)subcutaneously at a dose of 25 mg/kg on Day 13 and Day 27. The thirdgroup of mice received an isotype control antibody on Day 13 and Day 27.The anti-mlL-4Rα antibody used in this and the following Examples was anantibody comprising an HCVR with an amino acid sequence of SEQ ID NO:9and an LCVR with an amino acid sequence comprising SEQ ID NO:10.

Systemic anaphylaxis in this model manifests as a drop in coretemperature. Therefore, to assess the extent of anaphylaxis in thisexperimental system, mouse core temperature was measured over the courseof 180 minutes following the challenge injection. Results are shown inFIG. 1B. Untreated mice and mice receiving isotype control antibodyexhibited a rapid decrease in core body temperature at 30 minutes afterchallenge, indicating an anaphylactic reaction. Core temperature in thecontrol mice gradually increased to baseline by 180 minutespost-challenge. By contrast, mice that received anti-mlL-4Rα treatmentexhibited only a slight decrease in core body temperature at 30 minutespost-challenge, which returned to normal by the 60 minute time point.The difference in core body temperature change betweenanti-mlL-4Rα-treated mice and controls at the 30 minute time point wasstatistically significant (P<0.0001).

The terminal IgE level was also measured for each experimental group(FIG. 2). As shown, IL-4Rα blockade significantly decreased total IgElevels below the limit of detection as compared to untreated and isotypecontrol-treated animals.

The foregoing experiments involved two separate doses of anti-mlL-4Rαantibody (administered on D13 and D27). A second set of experiments wasnext conducted to assess the effect of a single administration on eitherDay 13 or Day 27 in the same peanut allergy model. An outline of theexperimental protocol is shown in FIG. 3A (D13 administration) and FIG.4A (D27 administration). Results are shown in FIGS. 3B and 4B,respectively. Mice receiving a single administration of anti-mlL-4Rαantibody on Day 13 exhibited significantly less anaphylaxis as comparedto untreated and control-treated animals (see FIG. 3B), however, theprotective effect was not as pronounced as in the two-doseadministration experiment (FIG. 1B). The protective effect ofanti-IL-4Rα treatment was substantially attenuated in the mice receivingsingle dose of antibody on Day 27 (see FIG. 4B).

In the single administration experiments, IgE levels were measured insamples taken from the animals at Day 12, Day 26 and Day 28. Results areshown in FIG. 5A (Day13 administration) and FIG. 5B (Day 27administration). Importantly, the effect of anti-mlL-4Rα antibody onsystemic anaphylaxis correlated with the degree of IgE inhibition. Thereduction in IgE levels was not immediate following anti-mlL-4Rαtreatment but appeared to require about 13 days from the time ofantibody administration until the time at which IgE levels were fullysuppressed. This Example therefore supports a role for IL-4R antagonismin preventing allergic reactions.

Example 2 Use of IL-4R Blockade in a Peanut Specific Immunotherapy Model

The purpose of this Example was to determine the effects of IL-4Rαblockade when added to an allergen-specific immunotherapy (SIT) regimen.For these experiments, a mouse peanut specific immunotherapy model wasdeveloped based in part on the model of Kulis et al., J. Allergy Clin.lmmunol. 127(1):81-88 (2011). Two sets of experiments were conducted, asdescribed below.

An outline of the experimental protocol used in the first set ofexperiments is shown in FIG. 6. Four groups of mice were used in theseexperiments. Three of the four groups of mice were subjected to a peanutspecific immunotherapy regimen comprising a Sensitization Phase, aBuild-up Phase, and a Challenge. The Sensitization Phase consisted ofadministration of 0.5 mg peanut extract +2 mg Alum administeredintraperitoneally on Days 0, 7 and 28. The Build-up Phase consisted oftwelve separate administrations of various doses of peanut extractwithout Alum on Days 49, 51, 53, 56, 58, 60, 63, 65, 67, 70, 72 and 74.The Challenge consisted of administration of 1 mg of peanut extract onDay 98.

The various treatment groups for these experiments were as follows:Group A received no immunotherapy and no antibody (“No IT”); Group Breceived immunotherapy only, without antibody (“IT”); Group C receivedimmunotherapy plus isotype control antibody on Days 36, 50, 57, 64 and71 (“IT+isotype control”); and Group D received immunotherapy plusanti-mlL-4Rα antibody (25 mg/kg, subcutaneous) on Days 36, 50, 57, 64and 71 (“IT+anti-IL-4Rα”). The anti-mIL-4Rα antibody used in theseexperiments was the same antibody as used in Example 1, herein.

To assess the extent of anaphylaxis in this system, mouse coretemperature was measured over the course of 180 minutes following thechallenge injection. In addition, serum samples were collectedthroughout the experiment (at Days 35, 46, 77 and 98) for immunoglobulinmeasurements. Anaphylaxis results are shown in FIG. 7. Total IgE, IgG1,IgG2a and IgG levels at Days 77 and 96 are shown in FIGS. 8, 9, 10 and11, respectively.

The results of these experiments show that allergen-specificimmunotherapy by itself protects against peanut-induced systemicanaphylaxis in this model (see FIG. 7). Importantly, administration ofan anti-IL-4Rα antibody did not interfere with the observed protectiveeffects of SIT. In addition, a trend towards increased IgE induced bySIT was observed in IT-only and IT+isotype control treated animals. Bycontrast, IgE production was blocked in anti-IL-4Rα-treated animals (seeFIG. 8). A tendency toward increased peanut-specific IgG1 titers wasobserved in animals treated with immunotherapy (with or without antibodytreatment), however statistical significance was only observed in the ITanimals at Day 77 (see FIG. 9). IL-4Rα blockade was also observed tocause an increase in peanut-specific IgG2a (see FIG. 10). The resultsfrom this first set of experiments provide experimental support for theuse of IL-4R blockade as a means to potentially improve the efficacy andsafety of allergen-specific immunotherapy.

A second set of experiments was next conducted to determine the effectof IL-4R blockade in a SIT regimen with fewer allergen doses during theBuild-up Phase. An outline of the experimental protocol used in thissecond set of experiments is shown in FIG. 12. As before, four groups ofmice were used in these experiments. Three of the four groups of micewere subjected to a peanut specific immunotherapy regimen identical tothe regimen used in the first set of experiments except that fewer dosesof allergen were administered during the Build-up Phase. In particular,the Build-up Phase in these experiments consisted of only eight (asopposed to twelve) separate administrations of various doses of peanutextract without Alum on Days 51 and 53 (0.1 mg), 58 and 60 (0.25 mg), 65and 67 (0.5 mg), and 72 and 74 (0.5 mg).

Again, four treatment groups were used (“No IT”, “IT only”, “IT+isotypecontrol”; and “IT+anti-IL-4Rα”). Antibody was administered at the samedose as before (25 mg/kg SQ), however injections were administered onDays 36, 49, 56, 63 and 70 (as opposed to Days 36, 50, 57, 64 and 71 inthe first set of experiments). The extent of anaphylaxis was determinedby measuring mouse core temperature over the course of 240 minutesfollowing the challenge injection. Results are shown in FIG. 13.

In these experiments, less frequent allergen administration during theBuild-up Phase was less protective against anaphylaxis as compared tothe more frequent dosing regimen used in the first set of experiments (8doses versus 12). In particular, a substantial drop in core bodytemperature in the IT and IT+isotype control mice during the first 60minutes after allergen Challenge was observed which was only slightlyless severe than what was observed in the “No IT” mice. By contrast,only a mild anaphylactic response (i.e., slight decrease in core bodytemperature) was observed in the anti-IL-4Rα-treated mice. The Build-upPhase in this model may be considered analogous to the maintenance phasein conventional SIT regimens in humans. The results from this Exampletherefore indicate that IL-4R blockade can substantially improve thesafety of allergen-specific immunotherapy regimens by allowing forreduced maintenance phase dosing. Less frequent allergen dosing wouldalso be more convenient and would result in greater patient compliancein SIT regimens.

The present invention is not to be limited in scope by the specificembodiments described herein. Indeed, various modifications of theinvention in addition to those described herein will become apparent tothose skilled in the art from the foregoing description and theaccompanying figures. Such modifications are intended to fall within thescope of the appended claims.

What is claimed is:
 1. A method for treating, preventing or reducing theseverity of an allergic reaction in a subject having an allergy to apeanut allergen, the method comprising administering to the subject atherapeutically effective amount of an interleukin-4 receptor (IL-4R)antagonist that is an antibody or an antigen-binding fragment thereofthat binds IL-4R, wherein the antibody or antigen-binding fragmentthereof comprises three HCDRs (HCDR1, HCDR2 and HCDR3) and three LCDRs(LCDR1, LCDR2 and LCDR3), wherein the HCDR1 comprises the amino acidsequence of SEQ ID NO:3, the HCDR2 comprises the amino acid sequence ofSEQ ID NO:4, the HCDR3 comprises the amino acid sequence of SEQ ID NO:5,the LCDR1 comprises the amino acid sequence of SEQ ID NO:6, the LCDR2comprises the amino acid sequence of SEQ ID NO:7, and the LCDR3comprises the amino acid sequence of SEQ ID NO:8.
 2. The method of claim1, wherein the method comprises administering multiple doses of theIL-4R antagonist to the subject before the manifestation of the allergicreaction.
 3. The method of claim 1, wherein the allergic reactioncomprises an allergic symptom that is selected from the group consistingof urticaria, angioedema, rhinitis, asthma, vomiting, respiratorycompromise, swollen lips, swollen tongue, and reduced blood pressure. 4.The method of claim 1, wherein the allergic reaction is anaphylaxis. 5.The method of claim 1, wherein the IL-4R antagonist is an antibody orantigen-binding fragment thereof that comprises a heavy chain variableregion (HCVR) comprising the amino acid sequence of SEQ ID NO: 1 and alight chain variable region (LCVR) comprising the amino acid sequence ofSEQ ID NO:
 2. 6. The method of claim 1, wherein the IL-4R antagonist isdupilumab.
 7. The method of claim 1, wherein the method comprisesadministering the IL-4R antagonist to the subject for at least two weeksbefore the manifestation of the allergic reaction.
 8. The method ofclaim 1, wherein the method comprises administering the IL-4R antagonistto the subject once every week or once every two weeks.
 9. The method ofclaim 1, wherein the IL-4R antagonist is administered in an amount from0.05 mg to 600 mg.
 10. The method of claim 9, wherein 300 mg of theIL-4R antagonist is administered.
 11. The method of claim 1, wherein theIL-4R antagonist is administered subcutaneously.
 12. The method of claim1, wherein the method further comprises administering to the subject asecond therapeutic agent.
 13. The method of claim 12, wherein the secondtherapeutic agent is selected from the group consisting of steroids,antihistamines, decongestants, and anti-IgE agents.
 14. The method ofclaim 1, wherein the IL-4R antagonist is contained in a syringe.
 15. Themethod of claim 1, wherein the IL-4R antagonist is contained in a pendelivery device.
 16. The method of claim 15, wherein the pen deliverydevice is prefilled.